A 7 year old male presents to the ER with a two day history of worsening ear pain and drainage. On the day prior to presentation, his parents noted redness behind his right ear, and that his right ear appeared to be sticking out. He had been well until 10 days ago when he started complaining of a cough and runny nose that progressed to include right ear pain and fever. He was evaluated in the clinic 5 days ago and diagnosed with an acute right otitis media. He was placed on amoxicillin and he initially appeared to improve until two days ago when his ear pain recurred and this is now accompanied by ear drainage, redness behind his right ear, and a prominent right pinna which is pointing up and out.